Technical meetings, conferences, and agency in global health
Authors: Girija Sankar
Journal: The Lancet Global Health (2022)

In an article recently published in Forbes, Madhukar Pai calls1Pai M Double agents in global health. Forbes, Feb 6, 2022https://www.forbes.com/sites/madhukarpai/2022/02/06/double-agents-in-global-health/?sh=24c4a6231a2eDate accessed: April 23, 2022Google Scholar people like me, ie, someone who was born and grew up in a low-income and middle-income country but now live and work in a high-income country, double agents in global health. Double agency implies agency—the ability to broker and effect change. We first must define who or what confers agency in global health, and who are the gatekeepers. Despite enjoying a position of privilege in a Global North organisation, and despite leading a professional network of practitioners, I find myself questioning who and what confers agency in global health. I reflected on a couple of major meetings happening in my professional sphere. One I was privy to, and another I was not. If I am not at a meeting, I do not get to meet colleagues I have not seen in a while, pick up on institutional news, or pick up the latest innovations pushing the frontiers of my research field. These often technical meetings are organised by credentialed leaders who control the funds and policy in global health; they are the gatekeepers who decide and confer agency in global health. Gatekeeping in global health is not the exclusive domain of leaders. You are a gatekeeper if you meet any of the following criteria. (1) You write, draft, or finalise an agenda for a meeting. Consider whether the agenda is inclusive. An agenda is a statement of power, influence, inclusion, and exclusion. A lot can be read between the lines on an agenda—the meeting venue, meeting hours, facilitators, presentations, and key notes are all subjective tools wielded to define knowledge access and production and underscore tribal allegiances between the influencers. Consider whether invited speakers are speaking about subject matters that are best left spoken by those the subject is about, or whether they are co-presenting. (2) You decide who gets to travel and not travel to meetings. I invite you to plan your meeting, then stop and reflect. Consider who can make it to the event or venue at this time of year; who is excluded and whether any exclusion is intentional; whether the exclusion is shared and with justification; and, if unintentional, whether the exclusion can be mitigated by holding the meeting virtually or by another means. (3) You work in global health serving so-called underserved vulnerable, or needy, community groups. Consider what you would do if a member of that community requested an invite. Is the restriction on invitations a function of budget, or is the invitation a function of who you think might have the most to say, and therefore, the most money or funding to contribute? Think about how your meeting may further perpetuate institutional and interpersonal inequities. (4) You control a budget. Consider whether the budget can be stretched by holding an event at a venue that might accommodate more participation, or in a country that does not have onerous visa requirements, particularly for participants from the Global South. (5) You are privy to closed-door meetings; or you sit on advisory councils, executive committees, or leadership boards. I invite you to stop, reflect, and ask the hard question about why you are the chosen expert and if you can use your authority to make it easier for people who do not look and speak like you to one day be a fellow expert. If you are at a professional meeting or hold a position of influence, you have a responsibility to be inclusive of people who do not speak, walk, talk, and eat like you do. You do not have to be a donor, director, chief executive office, or hold a business card to be a gatekeeper. You might be the gatekeeper. My definition of a gatekeeper is inclusive, in that it includes me. I write agendas, manage travel budgets, and plan meetings; however, I am always aware of my positionality in global health. I am aware of my privileges, and I represent my gender, race, ethnicity, and socioeconomics. Those of us who live in or are from the Global North and consider ourselves motivated by social justice can have intersectional blinkers on. On the one hand, I am an upper-caste, educated, and middle-class woman. My education, familial connections, and caste-associated privileges affected where I am today. My brownness does not confer any legitimacy to speak for or represent south Asian people of colour, let alone any person of colour. On the other hand, the social, cultural, and economic determinants of my gendered upbringing have undeniably influenced my values, career choice, and voice. I think it is a value I bring to my work, and it makes my work the richer for it. I invite other global health practitioners to this reflective exercise. I declare no competing interests. The opinions expressed in this comment are my own and do not reflect the opinion of my employer.